COHESION: Fighting diseases affecting the world's most vulnerable population

The University of Geneva (UNIGE) and Geneva University Hospitals (HUG) join forces with close to twenty researchers from partner institutions in Mo¬zambique, Nepal and Peru, as well as with the Graduate Institute and the Università della Svizzera italiana to address the double burden of chronic diseases (NCDs) and neglected tropical diseases (NTDs) affecting the most vulnerable populations in low and middle-income countries. Supported by the Swiss National Science Foundation and the Swiss Development Cooperation, the COHESION project - which stands for COmmunity HEalth System InnovatiON - aims to assess the current management of NTDs and NCDs in these countries, to understand its challenges and to develop country-specific interventions, in partnership with local stakeholders and taking into account cultural and gender issues. Multidisciplinary teams, comprising medical doctors, economists, health systems specialists as well as anthropologists, will then be able to really support the affected communities.

If communicable diseases remain among the major causes of mortality and morbidity in low- and middle-income countries, epidemiological records show that lifestyle changes and urbanization lead to a clear increase in chronic diseases, among which cardiovascular diseases, diabetes, cancer and respiratory diseases. Moreover, chronic diseases induce, on the long term, important cost of care, disability, lost productivity, and stigma. These conditions, which mostly affect the poorest, hence pose an important social and economic burden, not only on patients, but also on their families, on their communities and on health systems.

"The international community and the UN organizations have ignored NCDs and NTDs for far too long. But the awareness is now growing", states David Beran from UNIGE and the HUG, and COHESION principal investigator. "Effective interventions require a complete understanding of health systems and local contexts. This is the reason why we have assembled a multi-disciplinary team across four continents. Thanks to this feature, which is unique both in terms of competencies and the number of countries involved, we will be able to truly impact the health and well-being of the communities where we will be working."

A project focused on primary care

The COHESION project will take place in two steps. First, the researchers will use multiple research methods (literature reviews, global and national policies analysis, health systems assessment, qualitative interviews, quantitative surveys, etc.) to understand success of and barriers to the management of NTDs and NCDs. Then, building on the results of the studies conducted in three representative contexts, Mozambique, Nepal and Peru, they will develop interventions adapted to the local communities and to these countries primary health care structures, in partnership with local stakeholders and taking into account socio-cultural specificities.

Multiple synergies can be developed at policy, health systems and healthcare facilities levels to optimize preventive and curative care for both NCDs and NTDs, as well as for other health conditions. François Chappuis, professor at UNIGE Faculty of Medicine and head of the HUG Division of tropical and humanitarian medicine is very enthusiastic: « It is about time to forget vertical, disease-specific perspectives to engage into a much wider and effective approach integrated into primary health care! »

Solutions rooted in countries

Professor Albertino Damasceno underlines the importance of such a project for Mozambique, his country: "NCDs and NTDs, although recently recognized as proprietary areas of interest by the Ministry of Health, still have to compete with HIV/AIDS, Malaria and TB, that have received much more attention from local authorities as well as from international donors. COHESION will allow us to identify constraints and gaps, and, at last, foster a comprehensive management of all diseases affecting Mozambicans."

Dr Jaime Miranda from Peru ads: "For any given individual, when you approach the healthcare system, you expect a service of quality. Whether you have an NTD or an NCD, as a user, you expect an answer. Joining the response to these two types of diseases, both of which are chronic, allows for a pooling of resource, beyond sectoral approaches ».

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